A prospective cohort study investigating psychosocial predictors of attendance at a mobile breast screening service

Abstract: This study aimed to examine whether knowledge, attitudes and concerns predicted attendance at the mobile Breast X-Ray Programme in Sydney. A cohort study design was used, whereby women were surveyed prior to the implementation of the program, and two years later records were checked to determine whether they had attended for screening. Telephone interviews were sought with randomly selected women aged 45 to 70 years living in the central Sydney area (the screening van's catchment area). A total of 285 women was surveyed (response rate: 50 per cent). Of these, 86 (30 per cent) subsequently attended at the mobile van and 199 did not. Attendance did not appear to be related to any of the following factors: knowledge; attitudes; prior experience; perceived susceptibility and morbid concern in relation to breast cancer; the amount of information about screening mammography to which a woman had been exposed. The results are interpreted in light of methodological considerations plus findings from our other research.     

Evaluating the impact of a promotional campaign for screening mammography: women's knowledge and sources of awareness

Abstract: The Breast X-Ray Programme of the Central Sydney Health Service was advertised by generalised strategies aimed at the total community, including poster and pamphlet distribution, and strategies aimed at general practitioners, supplemented by written invitations and recommendation from the general practitioner, invitations for friends, and invitations from the service using the electoral listing. In order to evaluate the reach or impact of the promotional campaign in the Drummoyne local government area, telephone interviews were conducted with women aged 45 to 70 randomly selected from the community. Women's knowledge about breast cancer, screening and the Breast X-Ray Programme, plus sociodemographic characteristics, were obtained before screening (n = 628), 10 months (n = 93) and 2 years after screening started (n = 206). While knowledge about risk did not change, significant increases were found in the proportion of women who had heard of mammography, screening mammography specifically and the screening van. In addition there were significant increases in the proportion of women exposed to information about screening mammograms. The campaign generally had an equal effect on different sociodemographic but managed to achieve greater effects in women of non-English-speaking backgrounds and lower occupational status. A random sample of program attenders aged 45 to 70 (n = 763) were asked how they found out about the van. ‘Seeing the van’ was the most consistently reported source of awareness. Others included ‘GPs’, ‘newspapers’, ‘other print media’ and ‘personal networks’. Women with additional qualifications since leaving school were more likely to state ‘newspaper’ and ‘other print media’ as a source.     

A pivotal role for the general practitioner in a mixed mammographic screening model

BackgroundA mixed mammographic screening model presents a country or region with a complex problem. Promoting a significant shift within the target population from opportunistic breast cancer screening to participation in an organised screening programme offers many advantages. The objective was to explore the role of GPs as potential mediators by assessing their specific knowledge, attitudes, and experience on breast cancer and mammographic screening.MethodsA detailed questionnaire was mailed in 2007 to 1500 GPs randomly sampled from the GP population in the province of Antwerp, Belgium. Levels of knowledge on epidemiology and screening, opinions and attitudes on systematic mammographic screening, and experience with breast cancer and mammography were evaluated.ResultsWe received 317 completed questionnaires, 21.1% of the contacted GPs. General knowledge on basic concepts of mammographic screening was average, while the response to an open question on the differences between screening and opportunistic mammography was very limited. More than half of the participants had a positive or realistic attitude towards many aspects of systematic screening, and had satisfactory experience with breast cancer patients in their daily practice (about 82% saw one to four new cases a year). Many (72%) were favourably disposed towards systematic screening organised by the government.ConclusionThe answers of the GPs suggest a promising potential with regard to the official breast cancer screening programme. Many participants presented qualifications, which could contribute to a change from the mixed model in favour of the official screening system. A number of gaps, however, need to be filled and there is a continuing need to educate physicians on principles and risks and benefits of systematic screening of the target group.     

Survey on colorectal cancer screening knowledge, attitudes, and practices of general practice physicians in Lazio, Italy

BACKGROUND: Several international guidelines have recommended the involvement of general practitioners (GPs) in screening programs, but current evidence suggests this is very difficult. We implemented a survey to understand the attitudes, knowledge, and practices regarding colorectal cancer screening of GPs in the Lazio region. METHODS: Survey of all GPs working in 13 of the 50 districts in Lazio using a mail-in questionnaire. RESULTS: Out of 1192 GPs, 699 responded (59%). Ninety-four percent consider CRC a preventable disease. Knowledge about oncological screenings is higher in GPs using the guidelines as source of information. Twenty-five percent properly recommend the available screening tests for colorectal cancer, 22% do not recommend any, 6% under-recommend, and 47% over-recommend. Adequate knowledge of oncological screenings is positively associated with correct recommendation. Thirty-two percent of GPs recommend inappropriate follow-up tests for patients with positive fecal occult blood test. CONCLUSIONS: The low response rate reveals the lack of GP's interest in screening. Knowledge about screening and use of guidelines as sources of scientific information are important factors to improve attitudes about screening, but there is a large percentage of well-informed GPs who do not recommend colorectal cancer screening at all. Currently, many GPs do not properly follow the patients up after a positive FOBT.     

Evaluating the impact of a promotional campaign for screening mammography: who attends?

Abstract: The Breast X-ray Programme of the Central Sydney Health Service is one of 11 pilot programs in Australia assessing the best methods of delivering population-based mammographic screening. The aim of this study was to determine the attendance rate and to describe sociodemographic predictors of attendance in an area serviced by the program. A well-defined population of approximately 4500 women aged 45 to 70 was identified within the Central Sydney area for intensive testing of recruitment strategies. After four visits (spanning two years) to the area by a mobile screening van, 48% of the women were screened. Women from non-English-speaking backgrounds were just as likely to attend as women from English-speaking backgrounds, probably because special attention was given to recruiting these women. Older women from English-speaking backgrounds were less likely to attend, whereas no age trend existed for women of non-English-speaking backgrounds. Sampled attendance data of women from English-speaking backgrounds showed that women with more education were more likely to attend screening. Women who were employed were just as likely to attend as those who were not. In order to screen 70% of the targeted population as set forth for a national mammography screening program, it appears that community recruitment efforts alone will not be sufficient. With special attention to recruitment coverage, older women and women from non-English-speaking backgrounds can be successfully recruited. Special attention will also need to be focused on encouraging attendance in women who have less formal education.     

Mammogram uptake and barriers among Palestinian women attending primary health care in North Palestine

BackgroundBreast cancer affects women''s lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers.ObjectivesOur study aims to assess mammography screening uptake and barriers among women attending primary healthcare centres (PHCs) in northern Palestine.MethodsUsing an interviewer administered questionnaire, we used a cross-sectional study design to determine mammography screening uptake, knowledge and barriers among 357 women attending PHCs in Northern Palestine between December 2018 and March 2019.ResultsThe mean age was 50 years. The majority (69.2%) were considered to have adequate knowledge about breast cancer and mammography screening. Mammography screening uptake among the participants was 37%. Almost 85% of the women had a positive attitude towards breastfeeding as a prophylaxis factor against breast cancer, while the most frequent barrier to mammography screening was that the participants believed they did not have any symptoms (28.6%), followed by 22.1% of them who did not want to know if they had breast cancer.ConclusionThe findings of this study highlighted the low mammography uptake among Palestinian women despite the adequate knowledge of those women and the fully accessible and free screening programme. Hence, interventional strategies should be implemented at several levels to enhance mammogram uptake.     

Breast screening: GPs' beliefs, attitudes and practices.

OBJECTIVES: We aimed to describe GPs' knowledge, beliefs and attitudes towards breast screening, and their association with practice-based organizations of breast screening. METHOD: A stratified randomized sample of 158 GPs from within the North-East and North-West Thames Health Regions were interviewed. RESULTS: Sixty-five per cent of GPs report checking the accuracy of invitation lists, and differ from those who do not, in having more knowledge about risk factors for breast cancer. Thirty-seven per cent of GPs report a policy of following up non-attendees for screening and differ from those who do not in three ways: a greater perception of the threat of breast cancer; a greater belief in the importance of GPs' role in increasing attendance of women for breast screening; and, a less-negative attitude towards breast screening. CONCLUSION: Women's attendance for breast screening may be increased by raising GPs' perceptions of the threat of breast cancer, addressing their concerns about breast screening and enhancing their views of the importance of the role of primary care in a national screening programme.     

Women's perceptions of screening mammography

A random sample of women in Sydney were interviewed by telephone to determine their knowledge about and attitudes to mammography. A response rate of 56 per cent (628 women) was obtained. While the majority of women had had some experience with breast cancer, knowledge about which age groups were most at risk and treatment alternatives was limited. Only about half of the sample had heard about screening mammography before the survey. However, when a simple explanation was given, 79 per cent expressed a favourable attitude toward it. Only 22 per cent of women thought of themselves as being personally susceptible to breast cancer; the proportion was lower in women over 60 than in those in their 40s. Morbid concern about breast cancer was rare. About a quarter of the sample expressed concern about mammographically induced exposure to radiation. Attitudes and perceptions of personal susceptibility were not associated with knowledge about risks of breast cancer. However, having a favourable attitude and a lack of concern about radiation were associated with previously having heard about screening mammography. Women speaking a language other than English at home and from households where the main income earner was in an unskilled occupation were least likely to have heard of screening mammography. Suggestions for data-based recruitment strategies are discussed.     

Breast and cervical cancer screening: Knowledge, attitudes and behaviour among schoolteachers in Italy

The study explores knowledge, attitudes and behavior regarding screening for breast and cervical cancers. All female teachers in primary and secondary schools in Crotone and in Cassino (Italy) received a questionnaire on demographic and socioeconomic characteristics, clinical history, knowledge, behavior and attitudes about breast and cervical cancer and related screening procedures. A response rate of 65% was achieved. Knowledge on effectiveness of mammography and pap test in finding related cancers was widely spread in the sample. Only about 30% and 50% had respectively undergone their last mammogram and pap test according to the recommended time interval. Having been examined by a physician in the previous year and having had a screening CBE or a screening pap smear in the past three years were significantly more likely in women who underwent mammography for screening purposes in the past two years. Pap smear in the previous three years was significantly more likely in women in their forties, with a higher family income and in those who had been examined by a physician in the previous year. The results strongly recommend continued emphasis of physicians on education of women regarding mammography and pap smear.     

Reattendance of women for breast cancer screening programs. A review

BACKGROUND: In France, breast cancer is the most frequently occurring cancer and the leading cause of cancer deaths in women. Breast cancer screening has been shown to reduce breast cancer mortality by 30% provided attendance rate is 70% and re-screening interval is two to three years. Maintaining a high rate of reattendance is also important. The decline with time of completion rates of re-screening will lessen the benefits of a breast cancer screening program. METHODS: A review of published studies examining factors associated with attendance and reattendance to breast cancer screening. RESULTS: Positive views about initial screening are determining factors in reattendance: mammography should not be painful and embarrassing, appointments should be punctual and clinic staff courteous and supportive. Psychological factors influencing attendance also influence reattendance as does intention to participate, a major predictor of repeat participation and as do perceived susceptibility of breast cancer, perceived benefits of mammography, absence of emotional barriers. These factors can be modified by experience of previous screening. Other predicting factors of attendance continue to influence reattendance: practice of other preventive health behaviors, outside support from physicians, knowledge of breast cancer and screening. CONCLUSION: A better understanding of factors influencing attendance is necessary to increase the impact of breast cancer screening. Field studies are necessary to support the elaboration of publicity campaigns aimed at increasing participation.     

Mammography screening and trust: The case of interval breast cancer

Interval cancer is cancer detected between screening rounds among screening participants. In the Norwegian Breast Cancer Screening Programme, 19 per 10,000 screened women are diagnosed with interval cancer. We conducted semi-structured interviews with 26 such women. The women interpreted their interval breast cancer in two ways: that mammography can never be completely certain, or as an experience characterized by shock and doubts about the technology and the conduct of the medical experts. Being diagnosed with interval cancer thus influenced their trust in mammography, but not necessarily to the point of creating distrust. The women saw themselves as exceptions in an otherwise beneficial screening programme. Convinced that statistics had shown benefits from mammography screening and knowing others whose malignant tumours had been detected in the programme, the women bracketed their own experiences and continued trusting mammography screening. Facing a potentially lethal disease and a lack of alternatives to mammography screening left the women with few options but to trust the programme in order to maintain hope. In other words, trust may not only be a basis for hope, but also a consequence of it.     

Questionable data and preconceptions: reconsidering the value of mammography for American Indian Women.

Although the benefits of mammography are well established, many remain skeptical of the value of mammography for American Indian women. This skepticism stems in part from a belief that breast cancer is too rare an event among American Indians to warrant widespread screening. The validity of this assumption for Northern Plains Indians is challenged by a discussion of the limitations of available data on breast cancer in American Indian populations (including lack of generalizability, underestimation, and an overreliance on relative rather than absolute measures of cancer incidence) and by findings from the Minnesota Breast and Cervical Cancer Control Program, a federally funded program providing free breast and cervical cancer screening to American Indian and other women in Minnesota. In light of this information, the authors recommend that the low priority of mammography for American Indian women be reconsidered.     

Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel

The rates of mammography screening by Muslim Arab women in Israel are lower compared with the general population. The current study aimed to examine factors related to screening mammography behavior among Arab women by employing components from the Health Belief Model and the Theory of Reasoned Action. Sociodemographic factors, knowledge, beliefs about breast cancer and mammography, self-efficacy, cues to action, norms and intention to perform mammography were examined as explanatory variables for mammography use. Face-to-face interviews with a random sample of 510 Muslim Arab women, aged 50-69 years, were conducted. The women had limited knowledge about breast cancer and mammography, and the rate of mammography screening behavior (at the recommended interval) was only 20%. The women who were significantly more likely to undergo mammography were those who received a recommendation from a health professional or from family/friends, perceived themselves as vulnerable to getting breast cancer, believed in the efficacy of the test, perceived it as not painful, were younger, were more educated and were only of borderline significance among those who expressed an intention to undergo mammography. The findings indicate that professional recommendation and beliefs sets are essential factors for developing effective mammography screening interventions in this unique population.     

GPs' perceptions of the role of DEXA scanning: an exploratory study

BACKGROUND: Current recommendation are that women with clinical indicators of low bone mineral density should be offered a DEXA (dual energy X-ray absorptiometer) scan to help assess the need for treatment, but little is known about GPs' attitudes towards DEXA scans. OBJECTIVE: Our aim was to explore GPs' beliefs about diagnosis and management of osteoporosis, including the role that DEXA scanning can play. METHODS: Semi-structured interviews with five GPs in the North Staffordshire area were used to explore how GPs make decisions about diagnosis and treatment of osteoporosis, including the use of scans and the application of potential clinical risk factors to decisions about screening and treatment. RESULTS: The decision-making process about whether and who to scan is complex and was influenced by a range of factors including issues of diagnosis, treatment, patient pressure and 'external' factors such as practice protocol and the perceived local availability of scans. CONCLUSIONS: GPs found it difficult to decide who and when to scan despite guidelines for primary care. Perceived local availability of DEXA scans is important and has implications for raising awareness.     

Literacy and knowledge, attitudes and behavior about mammography in Latinas

This cross-sectional study explored the association between functional health literacy and the knowledge, beliefs, attitudes, and behavior about mammography and self-breast examination in a sample of Latinas attending community health clinics in Philadelphia. The results show that 70% of Latinas had inadequate or marginal functional health literacy. In Latinas, functional health literacy is only weakly associated with knowledge and not associated with beliefs and attitudes about screening mammography, but is significantly associated with having ever had a mammogram. After adjusting for demographic characteristics, functional health literacy was significantly associated with having ever had a mammogram (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.02-1.27). These findings suggest that Latinas with poor functional health literacy are less likely to undergo mammography. Future research should target increasing the knowledge about and rates of screening mammography in patients with low functional health literacy.     

Intervention tailoring for Chinese American women: comparing the effects of two videos on knowledge, attitudes and intentions to obtain a mammogram

This study utilized data from an ongoing randomized controlled trial to compare a culturally tailored video promoting positive attitudes toward mammography among Chinese immigrant women to a linguistically appropriate generic video and print media. Intervention development was guided by the Health Belief Model. Five hundred and ninety-two immigrant Chinese Americans from the metropolitan Washington, DC, and New York City areas completed telephone interviews before and after intervention. Changes in knowledge, Eastern views of health care (fatalism and self-care), health beliefs (perceived susceptibility, severity, benefits and barriers) and screening intentions were measured. Results showed that both videos improved screening knowledge, modified Eastern views of health care, reduced perceived barriers and increased screening intentions relative to print media (all P < 0.05). The generic video increased screening intention twice as much as the cultural video, although subgroup analysis showed the increase was only significant in women aged 50-64 years. Only Eastern views of health care were negatively associated with screening intentions after adjusting for all baseline covariates. These data suggest that a theoretically guided linguistically appropriate video that targets women from various ethnic groups is as efficacious in modifying attitudes toward mammography screening as a video that is exclusively tailored for Chinese immigrant women.     

Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study

AIMS: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice. METHODS: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire. RESULTS: Whereas training and support increased GPs' screening and brief intervention rates, it did so only for practitioners who already felt secure and committed in working with drinkers. Training and support did not improve attitudes towards working with drinkers and, moreover, worsened the attitudes of those who were already insecure and uncommitted. CONCLUSIONS: To enhance the involvement of GPs in the management of alcohol problems, interventions that increase both actual experience and address practitioners' attitudes is required. Such support could take the form of on-site support agents and facilitators.     

Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care

An exploration was made of attitudes and practices of general practitioners (GPs) and nurses concerning early identification of, and intervention for, alcohol-related problems. Sixty-five GPs and 141 nurses in 19 primary health centres in a county in southern Sweden answered a 28-item questionnaire before implementation of an intervention programme. The questionnaire covered experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. Self-reported frequency of asking about alcohol use was higher among GPs than nurses. Both groups reported more frequently asking about alcohol consumption in cases where they believed that the health status was influenced by alcohol. For both professions, knowledge and skills concerning identification were rated as better understood than that concerning intervention methods. Nurses rated their knowledge and skills less confidently than GPs. The overall attitude was fairly positive towards early identification and intervention, but nurses were more worried than GPs that patients would react negatively to questions about alcohol. Attitudes, self-rated capacity, and practice were related. The low level of early identification and intervention in primary care appears to be related more to insufficient practical skills than to attitudes. Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse-patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice.     

How is informed decision-making about breast cancer screening addressed in Europe? An international survey of 28 countries

The aim of this study was to develop a typology of approaches towards informed decision-making (IFD) about mammography screening in Europe. All countries collaborating in the European Commission Initiative on Breast Cancer were approached to participate. Experts from 28 European countries responded to a web-based survey providing data on key organisational and policy characteristics of breast screening at the national or regional level. A total of 35 responses were received including data from regionally organised breast screening in several countries. 27 respondents, covering 21 countries, reported the existence of a policy towards IFD and stated that they communicated to women about the benefit and risks. Few countries had attempted to measure the proportion of women making an informed choice. A cluster analysis of the survey responses allowed to identify three categories: countries in a confirmation phase who have adopted a policy specific to mammography screening; countries in an implementation phase with generic polices and limited administrative support dedicated yet to IFD; and countries in a decision phase who are deliberating how to address IFD. To the best of our knowledge, this study is the first to investigate the key policy and organisational characteristics of approaches taken to facilitate IFD in Europe. The results demonstrate a broad adoption of the principle of enabling IFD but indicate heterogeneity of implementation.     

A mobile breast screening project in Scotland: lessons learned for national screening

In 1986, a project was undertaken to determine the feasibility and cost of screening for breast cancer, using single oblique view mammography. Screening was offered to women aged between 40 and 65, on an open access basis, to those living in rural areas near Edinburgh. This article reports on: the logistical difficulties encountered; the costs of mobile screening; a comparison of costs when screening from a static centre; and, identifies factors found to influence attendance rates. The lessons learned from the project were incorporated into the planning of the mobile van operating in the South-East of Scotland Screening Programme, part of the National Breast Screening Programme; comparisons, where possible, have been included.